Nothing gets us more excited than talking about a not-so-little tweakment or a nip-tuck procedure. In the spirit of transparency, Marie Claire’s aesthetics column, Life in Plastic, delivers a first-hand peak into what goes on behind the doctor’s door.
After Doja Cat shared openly about undergoing liposuction to correct potential lipedema symptoms, more women are coming clean, too. Rachael is a 51-year-old woman living outside of Philadelphia. Over a two-year period, she had six liposuction surgeries performed on her arms, abdomen, waist, hips, thighs, and ankles to free her body from the symptoms associated with lipedema. This is her story, edited and condensed for clarity.
Content warning: The below article includes reference to disordered eating.
My whole life, I knew I was a little bit different. For as long as I can remember, the bottom half of my body never matched the top half. I had a small waist and thin arms, but my lower body was giant. I remember being about eight years old, wearing ridiculously short polyester gym shorts, when a boy in class looked at me and said, “Are you mad?” “Mad about what?” I asked. “That your legs are so big and don’t match the rest of your body?” I still remember it as if it were yesterday.
I’ve had lipedema, a chronic condition involving an abnormal buildup of fat, since puberty. I didn’t know I had it until four years ago. Lipedema is genetic, and it runs in my family. My mom and aunt had it, yet none of us were aware. All we knew was that we had these big, column-like, tree-trunk legs and large cankles that prevented us from wearing skirts and showing our knees.
For most of my life, I could never lose the extra weight or make my legs look small enough. I constantly worked out and dieted. I even went down the eating disorder route. Now I know it was lipedema.
“Lipedema is a distinct disease process that affects how fat is stored and distributed in the body. It is often associated with pain, tenderness, and easy bruising,” explains Dr. [Thomas] Su [MD, a cosmetic surgeon and the owner of Tampa-based ArtLipo]. “Lipedema fat behaves differently from normal fat. It is more fibrotic, more inflamed, and more resistant to the body’s normal metabolic processes. This is why patients often develop disproportionate volume, a nodular texture underneath the skin, and a column-like shape to the limbs.” Fast forward to my mid-30s. I went on the Atkins diet and was working out profusely—two to three times a day. I was constantly weighing myself because I was so obsessed with slimming down. While I lost some weight, I never got rid of my tree trunk legs, which bothered me so much. I couldn’t achieve defined-looking calves.
Then, my arms started to become affected. After seeing photos of myself, I noticed pockets of fat on both elbows that I never had before. The lipedema had spread to my arms. It grew into this very dense, very heavy, very sore fat pocket. Lipedema is strongly influenced by hormones, which is why Dr. Su says it often develops or worsens during puberty, pregnancy, or menopause. “These hormonal shifts can increase fat accumulation and make symptoms such as swelling and discomfort worse,” he adds.
Contents
How I Found My Doctor
Three years ago, while doom-scrolling Instagram, I came across a photo of a woman whose legs looked identical to mine. I started reading her story, and she mentioned she had lipedema. At the time, I had no idea what it was and that it plagued me. So, I immediately Googled it and went down a rabbit hole. I was checking off all the boxes and saying, “yes, yes, yes! This is me!”
I discovered a Facebook group dedicated solely to Dr. Su and some of his patients. Once I entered that group, I felt seen and heard, as if I belonged, because there were other women who had experienced everything I had.
I didn’t know surgery, specifically liposuction, was an option. A few women in the group had posted about their multiple surgeries to address lipedema, and I immediately knew I wanted to do it too. Lipedema is a disease, and I wanted to get as much of this diseased tissue out of my body. But I struggled with the idea of resorting to liposuction to get me to where I wanted to be. As an online fitness coach for 10 years, I felt like surgery meant that I was cheating, even though I knew liposuction was medically necessary for me. According to Dr. Su, currently, liposuction is the most effective surgical option for treating lipedema. “It removes diseased fat directly, helping reduce volume, improve mobility, and often relieves pain,” he says. “When done properly, liposuction can make a major difference in both function and appearance.”
I kept everything very quiet, very private, and very much to myself, telling only one friend, who was supportive but at times leery.
After receiving my official lipedema diagnosis at age 47, I traveled to Arizona to see board-certified endocrinologist and lipedema expert Karen Herbst, MD, for a second opinion. She confirmed a far more detailed diagnosis: stage 2, types 3 and 4, which meant I had lipedema in my arms, legs, and torso. I left feeling seen, understood, and, for the first time, hopeful about what was ahead for me. I realized I was advocating for myself after decades of being told to eat less and exercise more.
I started my journey to find the right surgeon. I had researched a few but kept circling back to Dr. Su. No results, at least in my opinion, come close to his, which are phenomenal. I also like that he has been doing lipedema liposuction surgeries for at least 10 years and has an artistic background. The other surgeons I was looking into seemed to show before-and-after images with smaller legs, but they weren’t sculpted, which was something I really wanted. Plus, with Dr. Su’s technique, he can remove about 85 to 90 percent of the tissue; other surgeons who can only get 50 to maybe 80 percent. That’s another reason why I wanted him to do my surgery.
My Liposuction Consultation
Before my consultation, which was done over Zoom, I was asked to take several photos in different poses, wearing a bathing suit or bra and underwear. During my virtual consult, he literally drew on my pictures with a marker, shading in areas where he would remove fat. I could envision what I would look like with beautifully sculpted knees, more defined calves, and tiny ankles. I told him I also wanted to do my arms, waist, and legs.
Together, we decided he would perform six separate liposuction surgeries, all done while I was awake. According to Dr. Su, awake liposuction allows the patient to remain conscious and actively tighten and hold their muscles in different positions for better control while sculpting and removing the fat. “This allows for smoother, more natural results and also avoids the risks of general anesthesia.”
Under Florida law (where Dr. Su practices), a maximum of four liters of fat can be removed per procedure. I’m a larger-framed woman, so I knew he would have to break this down into several smaller procedures for both safety and the best possible results. There’s also only so much lidocaine (a local anesthetic) that the body can tolerate.
I could envision what I would look like with beautifully sculpted knees, more defined calves, and tiny ankles
After my consultation, I decided to do my best to get the surgeries covered by my insurance, which I knew would be an uphill battle because insurance companies do not recognize lipedema. Only recently has it been as widely recognized as it is now. Plus, liposuction is almost always considered a cosmetic procedure.
My first go around, I was denied coverage. But with an accurate diagnosis and research that shows that surgery helps eliminate the diseased tissue from the body, finally, after almost one year, I was approved for all six of my surgeries.
My Six Liposuction Surgeries
I flew solo from Philadelphia to Tampa, Florida, for every one of my surgeries. I was a nervous wreck on surgery day and with each subsequent one thereafter. One nurse in particular, Tara, could tell how nervous I was and gently led me through a short meditation while I was lying on the table, which calmed me. I learned how to meet my nerves with intention, turning to deep breathing, meditation, and prayer to steady myself.
The first liposuction surgery that Dr. Su performed was on my abdomen. I was given some pre-op medication to help with any pain and nausea, and to prevent an infection. At the start of the procedure, I felt small “bee sting” injections as the numbing agent was administered. After that, there was some more anesthesia, but I was fully aware.
Then, a few months later, I went back to Tampa for liposuction on my knees and cankles. I wanted to get this one out of the way since it was supposed to be the most painful recovery. Since I was awake during the procedure, I remember lying on the table flexing my leg muscles and holding them in different positions while my [practitioner] was liposuctioning out the fat and literally sculpting around my muscles. There were moments of discomfort, but for the most part, liposuction felt more like pressure and movement rather than sharp pain.
Before and after liposuction on my abdomen.
(Image credit: Rachael*)
After one leg was done, he did a reveal. I sat up and started bawling my eyes out because, for the first time, my leg had a sculpted knee and a small ankle. It was one of the most moving moments of my life. Then, Dr. Su stood me up in front of a mirror so I could see the liposuctioned leg compared to the other. I can’t even describe the feeling of seeing my new, defined legs. He also had me raise my leg, which felt as light as a feather compared to the other one. Then, I hopped back on the table, and he started to liposuction my other leg.
Because I was awake, Dr. Su would talk me through what he was doing, keeping things light and reassuring. At a certain point, I would close my eyes, focus on my breathing, and let the voice in the operating room fade into the background. It became almost meditative in its own way. Going through each surgery awake wasn’t easy, but it was manageable.
Before and after liposuction on my lower legs and ankles.
(Image credit: Rachael*)
In December 2022, I did it again. This time, Dr. Su liposuctioned my waist, hips, and flanks. But, because at the time, I weighed 215 pounds, he had to break the surgery into two operations due to the maximum fat removal rules, otherwise I wouldn’t get the results I wanted. I’m glad we did it this way because Dr. Su was able to remove more fat, and the results are stunning.
Around this time, I also nailed down a surgery routine. I’d arrive in Tampa a few days before my surgery to prepare both mentally and physically and always stay at the same hotel. The day before surgery, I’d take a long walk along the water or sit quietly by the pool to ground myself. I was always nervous leading up to surgery, no matter how many procedures I’d had. Then, the night before my procedure, I’d set up my room with everything I needed, making sure everything was within reach. This became part of my process, and in a way, it helped me feel more in control. Even though I was physically alone, I never felt alone. My family checked in on me constantly, and I had a community of women on Facebook that were my lifeline throughout the entire journey.
Before and after arm liposuction.
(Image credit: Rachael*)
A few months later, Dr. Su [treated] my upper arms, which entailed the same steps as what was done during the surgeries for my legs. I was awake and tensing and flexing my arms, holding them in different positions as he sculpted them. Then, just like with my legs, I sat up and looked in the mirror, noticing an immediate difference in muscle definition between the treated arm and the non-treated one. For the first time ever, I saw my triceps and defined shoulders.
In the four months between my lower leg liposuction and my thigh procedure, each thigh had grown by two inches. The lipedema on the sides of my thighs was dreadfully painful. So, next, I went in for liposuction on my thighs with Dr. Su’s special procedure, 360 Thighs, which creates a smooth contour.
I thought my thighs would be my last surgery. It wasn’t.
Finally, I decided to do my forearms. They were the only untreated part of my body, and my lipedema had progressed badly there, so much so that it was affecting my grip strength. I couldn’t even hold a coffee cup. I was seeing a physical therapist for manual lymphatic drainage massages, and when she measured my pre-surgery and post-surgery grip strength, it went from 30 pounds to almost 70 pounds in one week! Besides giving me more sculpted arms, the surgery improved my grip strength tremendously.
My Liposuction Surgery Recovery
With each surgery—which ranged from 90 minutes to two hours, plus prep time—the recovery process was pretty much the same. I won’t say it was easy. A lot of people think liposuction is no big deal. It’s major surgery that causes trauma to the body.
Following each procedure, I always had a post-op appointment the day after surgery so Dr. Su could check everything, and his nurses could get me into fresh compression. I would fly home the following day. I wanted to recover in my own space and be home when swelling would peak, since flying can make it so much worse.
With each procedure, I took off plenty of time to give my body the proper rest it needed. When I had my legs and arms done, I stayed home and recovered for a good two weeks. I spent most of my time relaxing while wearing compression garments, which are mandatory for two weeks. I wore them a little longer because they help the skin retract more, so everything is smoother. I find it more comfortable to wear compression, even though I have a love-hate relationship with it, because it’s comforting and soothing in a weird way.
I also made sure to focus on eating anti-inflammatory foods, plenty of protein, and staying hydrated (I also followed this same routine leading up to each surgery).
Before and after my six liposuction surgeries to treat lipedema.
(Image credit: Rachael*)
“Swell hell” happened after each surgery, somewhere between days four and six. For one week, my body would be at its peak level of swelling. Every day, I’d think my body couldn’t possibly swell anymore, but it did. I would cry in the shower thinking, “What have I done to myself?” At this point, I didn’t look like myself; I was so swollen. I looked worse than before. I’m lucky I had my support groups and women telling me to hang in there and that all this is normal.
I would rest and walk as much as possible, but at first, it was tough. A walk entailed either a shuffle out to the mailbox or a slow, careful walk up and down the stairs. I would also get on my stationary bike and try to move my legs just a little bit, even though my body didn’t really want to.
The recovery process left me tired—almost exhausted. I just kept remembering that I had to let my body heal.
Around day 11 post-op, I would start to feel more like myself. At this point, the swelling would begin to ease, and I could see the results peeking through. I had manual lymphatic drainage about two weeks post-op. I found it incredibly helpful for swelling. I also incorporated hyperbaric oxygen treatments, cryotherapy, and red-light therapy to support healing. More than anything, I listened to my body.
My Liposuction Results
Now that everything has settled, I’m extremely happy with my results. I feel they are even better than the drawings my doctor made during my consultation. That’s how amazing his work is.
One area where I saw the biggest change was my arms. Here I was, working out my arms so hard for years, but I could never see my muscles because they were hidden by so much dense, heavy, diseased lipedema tissue. Once all that was removed, I could see my arms.
Most people can’t believe I did this surgery six times. And sometimes I couldn’t believe I was doing what I was doing. But it’s only because my results are so phenomenal. And I’m not just speaking from an aesthetic sense. Being able to walk without pain and not feeling heavy and weighed down—I literally felt like I had sandbags strapped to my ankles—is a game-changer. For years, I normalized all this pain. I just thought it was the way my legs were. So, to go from that to feeling no pain at all is huge.
I just went on a vacation, and it was the first time since my surgeries that I wore a bikini. Having this newfound confidence is more than I ever dreamed of, because I spent so much of my life hiding behind pants. All of this has been a dream come true, and I still pinch myself. Every time I pass a mirror, I want to pull up my pants and look at my legs.
Of course, some days, I wake up and wonder if my lipedema will return, so that’s a constant fear. Some people say it can return, so I do everything I can to keep it at bay. I’m three years out, and my lipedema has not regrown because I’m basically a living experiment. I didn’t go through six surgeries and recovery hell just to blow my diet. I also take a GLP-1, which research shows helps keep lipedema at low levels and reduces inflammation. I do everything I can to prevent it from returning: lymphatic drainage massage, vibration plates, and red light therapy—it’s a lifestyle change.
If there’s one thing I could say to anybody who has lipedema or thinks they have it, know that you’re not alone, and it’s not your fault. It’s important to seek a diagnosis from someone well-versed in lipedema. So many doctors don’t know about this condition, so you must be your own advocate and not give up. But once you have an answer, it can provide a path forward, whether with or without surgery. I chose surgery, but not everyone can or wants to. I would go through every single surgery again for the physical, mental, and emotional transformation it gave me. Being in a new body is something I can’t explain. I still pinch myself. It’s like a dream.
Meet the Expert
Dr. Thomas Su is the owner and cosmetic surgeon of Artistic Lipo and specializes in awake-only liposuction. Dr. Su is defined by his passion for art since high school, resulting in a bachelor’s degree in fine arts. His love for art and the human figure is apparent in all his work and is the reason for his high degree of perfectionism when it comes to liposuction. Dr. Su is the innovator of the Interactive Lipo Method and Celebrity Arms Sculpting. He also authored the book Celebrity Arms in a Day – Body Sculpting with the New Interactive Lipo Method.
TOPICS
